Abnormalities of left atrial function after cardioversion: an atrial strain rate study

Liza Thomas ^1*, Tanya Mckay ², Karen Byth ² and Thomas H Marwick ³

¹ University of Sydney/ Westmead Hospital, Australia
² Westmead Hospital, Australia
³ University of Queensland/ Princess Alexandra Hospital, Australia

^* To whom correspondence should be addressed. E-mail: lizat{at}westgate.wh.usyd.edu.au.

Accepted 23 June 2006

Abstract

Objectives: The role of atrial myocardial dysfunction after cardioversion is unclear. In a comparison of patients after successful cardioversion from chronic atrial fibrillation (CAF) and normal controls, we sought to determine whether Doppler-derived atrial strain rate (A-sr) could be used to measure global left atrial function and whether A-sr was reduced in patients with CAF.

Methods: A-sr was measured from the basal septal, lateral, inferior and anterior atrial walls from the apical 4 and 2 chamber views in 37 subjects with CAF who had been cardioverted to sinus rhythm (SR) and followed for 6 months and a cohort of 37 healthy individuals. Conventional measures of atrial function included peak transmitral A wave velocity, A wave velocity time integral (VTI), atrial fraction and the left atrial ejection fraction. Doppler tissue imaging was used to estimate atrial contraction velocity (A' velocity). In addition to amplitude parameters, the time to peak A-sr (tA-sr), was measured from aortic valve closure.

Results: Immediately following cardioversion, A-sr in the CAF cohort (baseline) was significantly lower compared with normals (-0.53 ± 0.31 s-1 vs -1.6 ± 0.75 s-1; p<0.001); the A-sr correlated with A’ velocity (r = 0.63; p<0.001) within patients. Atrial function improved over time, with maximal change observed in the initial 4 weeks post cardioversion. tA-sr was increased in the CAF group compared to controls (0.55 ± 0.15 vs 0.46 ± 0.12 s), but this failed to normalize over time.

Conclusion: A-sr is a descriptor of atrial function, which is reduced after cardioversion from CAF and subsequently recovers.

Keywords: atrial fibrillation, atrial function, atrial strain rate, echocardiography

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